Medical adhesive-related skin injury

Medical adhesive-related skin injury (MARSI) is defined as:

A MARSI is a result of mechanical skin stripping and can create painful, partial-thickness skin damage which will compromise the skin’s barrier function (Fumarola et al, 2020; Thayer, 2021). MARSIs can occur in any patient group or setting. However, these injuries are largely avoidable with the use of preventative measures, which includes ensuring at-risk patients are advised to adopt a skin care regimen.

A MARSI can present in many ways. The first sign of potential skin damage following the removal of a product containing a medical adhesive is erythema (redness) of the skin where the product was attached. This often mirrors the outline of the part of the dressing or device that contains the medical adhesive. This erythema may disperse if the skin in the area is recovering but should always be viewed as having potential for MARSI development (McNichol et al, 2013; Fumarola et al, 2020). If the erythema persists or deteriorates further, this would be considered skin damage related to medical adhesive use.

Such skin damage (MARSI) can present in several different ways (Table 1; Figure 1) and can be broken down into three distinct categories.

The most common cause of a MARSI is the removal of a dressing or device that contains a medical adhesive. This can result in skin-stripping (Cutting, 2008), or the skin can be torn during the removal process (Tielemans and Voegeli, 2019). In addition, this removal can put the skin under tension or expose it to frictional forces (Lustig et al, 2021). Other causes are related to the skin’s reaction to the components of the adhesive product, which can manifest as contact dermatitis. In addition, because of moisture trapping under the adhesive dressing or device, maceration can occur (Bernatchez and Bichel, 2023). Bacteria can also be trapped, potentially causing skin infections and/or a folliculitis (Fumarola et al, 2020).

The diagnosis of a MARSI involves looking at two specific factors:

1. Does the patient have, or have they had, a medical adhesive containing dressing or device in the area where there is skin damage?
2. Does this skin damage fall under any of the categories in Table 1?

If the answer is yes to both questions, then a diagnosis of MARSI can be given. However, it is imperative that the type of skin damage is clearly documented, including a clear plan for its management. This is essential, as the management of a skin tear would be different to the management of a folliculitis, for example. The management plan would also discuss the prevention of further skin damage from the medical-adhesive dressing or device.

The first step in preventing a MARSI is to identify who is at risk of developing one. Anyone who is having a dressing or device applied that contains a medical adhesive is at-risk. However, certain groups are particularly vulnerable to MARSI development. These include:

• neonates and older people
• patients who are malnourished and/or dehydrated
• those with oedema
• patients with existing skin disorders, e.g. eczema
• those with underlying comorbidities, e.g. immunocompromised/suppressed, diabetes, renal impairment, long-term steroid use (McNichol and Bianchi, 2016)

Once identified as at-risk of a MARSI, preventative measures should be put in place. These should include:

• An initial, and on-going, assessment of the patient’s overall skin condition
• If vulnerable skin is identified, then a skin care regimen should be instigated (Table 2)
• Use a product containing a medical adhesive only if necessary
• Check the patient is not allergic to any of the ingredients used in the products that will

The management of the MARSI will depend on the type and presentation of the MARSI. The management of a MARSI will also include ongoing evaluation of its progress and use of preventative measures to ensure skin damage is not extended.

Education in the prevention of a MARSI for the patient, their family and health care professionals is pivotal to maintain awareness of MARSIs and to reduce their incidence.

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